ACC: Early Eptifibatide Not Beneficial in Coronary Syndrome

Outcomes not significantly different compared to delayed use and bleeding is more common

By Rick Ansorge

HealthDay Reporter

MONDAY, March 30 (HealthDay News) -- In patients with acute coronary syndromes without ST-segment elevation, early use of eptifibatide does not lead to better outcomes compared to delayed use and may be associated with an increased risk of bleeding that necessitates transfusion, according to a study published online March 30 in the New England Journal of Medicine to coincide with the American College of Cardiology's 58th Annual Scientific Session held March 29 to 31 in Orlando, Fla.

Robert P. Giugliano, M.D., of Brigham and Women's Hospital in Boston, and colleagues randomly assigned 9,492 patients to receive either early eptifibatide at least 12 hours before angiography or a matching placebo infusion with provisional use of eptifibatide after angiography.

The researchers found that there were no significant group differences in the primary outcome: a composite of death, myocardial infarction, recurrent ischemia requiring urgent revascularization, or the occurrence of a thrombotic complication during percutaneous coronary intervention at 96 hours (9.3 percent in the early group versus 10 percent in the delayed group). They also found that early eptifibatide was associated with significantly higher rates of non-life-threatening bleeding and red-cell transfusion.

"However, in the early-eptifibatide group, there was a trend toward fewer recurrent ischemic events at 30 days," the authors conclude. "On the basis of these results, a routine strategy of administering eptifibatide in patients early after presentation cannot be recommended."

The study was supported by Schering-Plough and Millennium Pharmaceuticals; several authors disclosed financial relationships with Schering-Plough.